1. The utilisation of CT colonography in patients symptomatic for colorectal cancer
The capacity challenge:
Within Guy’s and St Thomas’ NHS Foundation Trust, colon cancer is one of the two most difficult areas in terms of delivering cancer targets
New NICE guidelines published in June 2015 have broadened the inclusion criteria for urgent cancer referrals for patients who are symptomatic for colon cancer.
This means an increased number of urgent ‘2 Week Wait’ referrals to the Trust.
Background
Colorectal cancer is the third most common cancer in the UK and the second most common cause of cancer death in the UK
CRC has an annual incidence of approximately 40,000 new cases
Less than 10% of patients referred to NHS outpatient clinics on suspicion of CRC are actually diagnosed with the disease
Increasing demand for optical colonoscopy is placing a considerable pressure on workload for secondary care
STUDY AIM: The TOHETI study aims to assess whether a change in the current diagnostic pathway, replacing optical colonoscopy with CT colonography as the first-line test for symptomatic patients, will increase early detection of colon cancer, improve outcomes and have cost-saving benefits.
Study details
The study will take place in the Colorectal and Gastroenterology Units at Guy’s and St Thomas’ NHS Foundation Trust.
Patients taking part in the study will undergo either a CT Colonography or an Optical Colonoscopy examination, as per Guy’s and St. Thomas’ current standard of care.
Referral to Optical Colonoscopy will be the first imaging test as per GSTT’s standard of care during Phase 1
Referral to CT Colonography will be the first imaging test as per GSTT’s standard of care during Phase 2
The study aims to recruit 246 patients in total (123 patients in each group).
Target group is patients referred for change in bowel habit requiring large bowel investigation
Improvements to the bowel prep service have also been introduced, following patient feedback on their experience.
The Study pathway:
Outcomes
Expected impact
Patient experience and satisfaction
Increased patient experience for patients undergoing the CT colonography-based pathway
Quality of care
Increased quality of life associated with the proposed pathway
Shift of optical colonoscopy capacity to diagnose high risk CRC patients
Cost-effectiveness
Decreased overall cost per patient
Increased cost-effectiveness in the management of symptomatic CRC patients
“It is well established in the literature that CT colonography has an equivalent diagnostic accuracy to optical colonoscopy in the detection of medium sized polyps and cancers in the large bowel.
At present it is an under-utilitised resource in our trust. This study will offer improved access to CT colonography as a non-invasive first line test for patients with large bowel symptoms.
The outcome of this study will then help facilitate discussions on a revised Colon Cancer pathway in our trust, which should be more cost effective, with improved patient experience, and reduced waiting times.”
Nyree Griffin, Consultant Radiologist, Gastrointestinal Imaging; Chief Investigator, TOHETI Colon study
CONTACT US: Project Manager: Ms Bharti Malhotra Ext